An overview of levodopa in the management of restless legs syndrome in a dialysis population: Pharmacokinetics, clinical trials, and complications oftherapy

OBJECTIVE: To review published literature investigating the efficacy and sa fety of levodopa. in the management of restless legs syndrome (RLS) with em phasis on the hemodialysis population. DATA SOURCES: An English-language literature search using MEDLINE was condu cted from 1966 to 1997 (key terms. restless legs syndrome, levodopa, hemodi alysis). The bibliographies of all identified published articles were revie wed and cross-referenced to ensure that all possible references were identi fied. STUDY SELECTION AND DATA EXTRACTION: All identified human studies investiga ting the use of levodopa for the management of RLS in uremic and nonuremic patients were analyzed. RESULTS: The prevalence of RLS is 20-40% in patients with end stage renal d isease (ESRD) and approximately 5% in the general population. Although the benefits of levodopa/(carbidopa/ benserazide) in reducing the signs and sym ptoms of RLS are documented in nonuremic patients, evidence in patients wit h ESRD is less readily available. Three small(<30 subjects) clinical trials in uremic patients provide preliminary evidence for the usefulness of levo dopa/(carbidopa/benserazide) in this population. CONCLUSIONS: In general, the small amount of published literature supports the empirical use of levodopa/carbidopa as a safe and effective therapy to manage the distressing symptoms of RLS in a hemodialysis population. We als o report personal observations over a 4-year period in our hemodialysis uni t that support levodopa as an effective first-line therapy. We have averted suicidal ideation in two patients and frequently modified symptoms of seve re sleep deprivation. The dose of levodopa/carbidopa must be individually t itrated to each patient's symptomatology, and morning rebound and afternoon augmentation should be monitored.